CDE Detailed Report
Disease: Huntington's Disease
Sub-Domain: Epidemiology/Environmental History
CRF: Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia
Displaying 1 - 20 of 20
Sub-Domain: Epidemiology/Environmental History
CRF: Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia
Displaying 1 - 20 of 20
| CDE ID | CDE Name | Variable Name | Definition | Short Description | Additional Notes (Question Text) | Permissible Values | Description | Data Type | Disease Specific Instructions | Disease Specific Reference | Population | Classification (e.g., Core) | Version Number | Version Date | CRF Name (CRF Module / Guideline) | Sub Domain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | External Id Loinc | External Id Snomed | External Id caDSR | External Id CDISC |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C16619 | Risk Factor Questionnaire (RFQ) - significant injury treatment administered text | RFQSignfcntInjTreatmtAdmTxt | The free text field to specify the treatment administered for any significant injury as part of the risk factor questionnaire (RFQ). | The free text field to specify the treatment administered for any significant injury as part of the Risk Factor Questionnaire (RFQ). | Yes, | Alphanumeric |
Seek Treatment for Injury? |
Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. | Adult | Exploratory | 3.00 | 2013-07-14 19:48:50.273 | Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C16620 | Risk Factor Questionnaire (RFQ) - significant injury treatment hospitalization indicator | RFQSignfcntInjTreatmtHospInd | The indicator of whether the participant/subject was hospitalized for injury as part of the risk factor questionnaire (RFQ). | The indicator of whether the participant/subject was hospitalized for injury as part of the Risk Factor Questionnaire (RFQ). | Hospitalized for this Injury? | Yes;No;Don't know | Yes;No;Don't know | Alphanumeric |
Only complete if Yes was answered for "Has the participant/ subject ever had any significant injury that caused them to seek treatment" |
Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. | Adult | Exploratory | 3.00 | 2013-07-14 19:48:50.273 | Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C08032 | Risk Factor Questionnaire (RFQ) - significant injury surgery anesthesia administered type | RFQSignfcntInjSxAnesthAdmType | Type of anesthesia given to participant/subject as part of the Risk Factor Questionnaire (RFQ). | Type of anesthesia given to participant/subject as part of the Risk Factor Questionnaire (RFQ). | Type of Anesthesia Used | General;Local;Other, specify;Spinal block | General;Local;Other, specify;Spinal block | Alphanumeric |
No instructions available |
Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. | Adult;Pediatric | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C16621 | Risk Factor Questionnaire (RFQ) - significant injury treatment immobilized cast indicator | RFQSignfcntInjTxImmobCstInd | The indicator of whether any body part(s) were immobilized or needed a cast as a result of the injury as part of the risk factor questionnaire (RFQ). | The indicator of whether any body part(s) were immobilized or needed a cast as a result of the injury as part of the Risk Factor Questionnaire (RFQ). | Body Part(s) Immobolized or Need Cast? | Yes;No;Don't know | Yes;No;Don't know | Alphanumeric |
Only answer if Yes was answered for "Has the participant/ subject ever had any significant injury that caused them to seek treatment" |
Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. | Adult | Exploratory | 3.00 | 2013-07-14 19:48:50.273 | Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C16611 | Risk Factor Questionnaire (RFQ) - significant injury treatment indicator | RFQSignfcntInjTreatmtInd | The indicator whether a participant has had any significant injury to cause him/her to seek treatment as part of the risk factor questionnaire (RFQ). | The indicator whether a participant has had any significant injury to cause him/her to seek treatment as part of the Risk Factor Questionnaire (RFQ). | Have you ever had any significant injury that caused you to seek treatment? | Yes;No;Don't know | Yes;No;Don't know | Alphanumeric |
Include any type of injury, such as sprains/strains, fractures, contusions or severe bruises, burns, lacerations, or whiplash for which you sought treatment. |
Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. | Adult | Supplemental | 3.00 | 2013-07-14 19:48:50.273 | Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C16622 | Risk Factor Questionnaire (RFQ) - significant injury lasting effects indicator | RFQSignfcntInjLastEffectInd | The indicator of whether the participant/subject had lasting effects from the injury as part of the risk factor questionnaire (RFQ). | The indicator of whether the participant/subject had lasting effects from the injury | Lasting Effects from this Injury? | Yes;No;Don't know | Yes;No;Don't know | Alphanumeric |
No instructions available |
Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. | Adult | Exploratory | 3.00 | 2013-07-14 19:48:50.273 | Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C16612 | Risk Factor Questionnaire (RFQ) - significant injury name | RFQSignfcntInjName | Name of injury sustained by participant/subject as part of the risk factor questionnaire (RFQ) | Name of injury sustained by participant/subject as part of the Risk Factor Questionnaire (RFQ) | Type of Injury | Alphanumeric |
Type of Injury and Body Part(s) Involved |
Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. | Adult | Supplemental | 3.00 | 2013-07-14 19:48:50.273 | Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C16623 | Risk Factor Questionnaire (RFQ) - significant injury lasting effects text | RFQSignfcntInjLastEffectTxt | The free text field to specify the lasting effects from the injury as part of the risk factor questionnaire (RFQ). | The free text field to specify the lasting effects from the injury | Yes, | Alphanumeric |
Lasting Effects from this Injury? |
Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. | Adult | Exploratory | 3.00 | 2013-07-14 19:48:50.273 | Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C16613 | Risk Factor Questionnaire (RFQ) - significant injury anatomic site | RFQSignfcntInjAntmicSite | Anatomic site of injury sustained by participant/subject as part of the risk factor questionnaire (RFQ) | Anatomic site of injury sustained by participant/subject as part of the Risk Factor Questionnaire (RFQ) | Body Part(s) | Alphanumeric |
Type of Injury and Body Part(s) Involved |
Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. | Adult | Supplemental | 3.00 | 2013-07-14 19:48:50.273 | Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C16624 | Risk Factor Questionnaire (RFQ) - significant injury surgery administered name | RFQSignfcntInjSxAdmName | Anatomic site of the surgery performed as part of the risk factor questionnaire (RFQ). | Anatomic site of the surgery performed as part of the Risk Factor Questionnaire (RFQ). | Body Part(s) Involved | Alphanumeric |
No instructions available |
Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. | Adult | Exploratory | 3.00 | 2013-07-14 19:48:50.273 | Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C16614 | Risk Factor Questionnaire (RFQ) - significant injury age value | RFQSignfcntInjAgeVal | Age in years of the participant/subject at the time of the injury as part of the risk factor questionnaire (RFQ) | Age in years of the participant/subject at the time of the injury as part of the Risk Factor Questionnaire (RFQ). | Age at injury | Numeric Values |
(first/next) |
Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. | Adult | Supplemental | 3.00 | 2013-07-14 19:48:50.273 | Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia | Epidemiology/Environmental History | Participant History and Family History |
Free-Form Entry |
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| C16625 | Risk Factor Questionnaire (RFQ) - significant injury surgery administered anatomic site | RFQSignfcntInjSxAdmAntmicSite | The name of the surgery performed as part of the risk factor questionnaire (RFQ). | The name of the surgery performed as part of the Risk Factor Questionnaire (RFQ). | Type of Surgery | Alphanumeric |
No instructions available |
Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. | Adult | Exploratory | 3.00 | 2013-07-14 19:48:50.273 | Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia | Epidemiology/Environmental History | Participant History and Family History | 255 |
Free-Form Entry |
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| C16615 | Risk Factor Questionnaire (RFQ) - significant injury school work missed indicator | RFQSignfcntInjSchoolWrkMissInd | Indication of whether the participant/subject missed school or work because of the injury as part of the risk factor questionnaire (RFQ) | Indication of whether the participant/subject missed school or work because of the injury as part of the Risk Factor Questionnaire (RFQ) | School or Work missed? | Yes;No;Don't know | Yes;No;Don't know | Alphanumeric |
No instructions available |
Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. | Adult | Supplemental | 3.00 | 2013-07-14 19:48:50.273 | Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C16626 | Risk Factor Questionnaire (RFQ) - significant injury surgery administered year age value | RFQSignfcntInjSxAdmYrAgeVal | Year or Age of participant/subject at time of surgery as part of the risk factor questionnaire (RFQ). | Year or Age of participant/subject at time of surgery as part of the Risk Factor Questionnaire (RFQ). | Year or Age of Surgery | Numeric Values |
Answer should be recorded as an integer. Only answered if Yes was answered for "Have you ever had surgery for any reason?" |
Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. | Adult | Exploratory | 3.00 | 2013-07-14 19:48:50.273 | Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia | Epidemiology/Environmental History | Participant History and Family History |
Free-Form Entry |
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| C16616 | Risk Factor Questionnaire (RFQ) - significant injury school work missed duration | RFQSignfcntInjSchoolWrkMissDur | Unit of measure for length of time the participant/subject missed school or work because of the injury as part of the risk factor questionnaire (RFQ) | Length of time the participant/subject missed school or work because of the injury as part of the Risk Factor Questionnaire (RFQ) | If Yes, how long? | Numeric Values |
If School or Work missed? |
Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. | Adult | Supplemental | 3.00 | 2013-07-14 19:48:50.273 | Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia | Epidemiology/Environmental History | Participant History and Family History |
Free-Form Entry |
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| C16627 | Risk Factor Questionnaire (RFQ) - significant injury surgery administered year age unit of measure | RFQSignfcntInjSxAdmYrAgeUOM | Year or Age unit of measure of participant/subject at time of surgery as part of the risk factor questionnaire (RFQ). | Year or Age unit of measure of participant/subject at time of surgery as part of the Risk Factor Questionnaire (RFQ). | Year or Age of Surgery | Year;Age | Year;Age | Alphanumeric |
No instructions available |
Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. | Adult | Exploratory | 3.00 | 2013-07-14 19:48:50.273 | Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C16617 | Risk Factor Questionnaire (RFQ) - significant injury school work missed duration unit of measure | RFQSignfcntInjSchlWrkMssDurUOM | Unit of measurement for the length of time the participant/subject missed school or work because of the injury as part of the Risk Factor Questionnaire (RFQ) | Unit of measurement for the length of time the participant/subject missed school or work because of the injury as part of the Risk Factor Questionnaire (RFQ) | If Yes, how long? | Day;Week;Month | Day;Week;Month | Alphanumeric |
If School or Work missed? |
Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. | Adult | Supplemental | 3.00 | 2013-07-14 19:48:50.273 | Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C17696 | Risk Factor Questionnaire (RFQ) - significant injury surgery administered indicator | RFQSignfcntInjSxAdmInd | The indicator of whether surgery was performed as part of the Risk Factor Questionnaire (RFQ). | The indicator of whether surgery was performed as part of the Risk Factor Questionnaire (RFQ). | Have you ever had surgery for any reason? | Yes;No;Don't know | Yes;No;Don't know | Alphanumeric |
Please include any outpatient surgical procedures and any oral/dental surgeries you may have had. |
Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. | Adult | Supplemental | 3.00 | 2013-08-30 17:06:52.8 | Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C16618 | Risk Factor Questionnaire (RFQ) - significant injury treatment administered indicator | RFQSignfcntInjTreatmtAdmInd | The indicator whether a participant had treatment administered for any significant injury as part of the risk factor questionnaire (RFQ). | The indicator whether a participant had treatment administered for any significant injury as part of the Risk Factor Questionnaire (RFQ). | Seek Treatment for Injury? | Yes;No;Don't know | Yes;No;Don't know | Alphanumeric |
Seek Treatment for Injury? |
Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. | Adult | Supplemental | 3.00 | 2013-07-14 19:48:50.273 | Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia | Epidemiology/Environmental History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C18750 | Risk Factor Questionnaire (RFQ) - significant injury surgery anesthesia administered other text | RFQSignfcntInjSxAnesthAdmOTH | The free-text field related to 'Risk Factor Questionnaire (RFQ) - significant injury surgery anesthesia administered type' specifying other text. Type of anesthesia given to participant/subject as part of the Risk Factor Questionnaire (RFQ). | The free-text field related to 'Risk Factor Questionnaire (RFQ) - significant injury surgery anesthesia administered type' specifying other text. Type of anesthesia given to participant/subject as part of the Risk Factor Questionnaire (RFQ). | Other, specify | Alphanumeric |
No instructions available |
Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. | Adult;Pediatric | Supplemental | 1.00 | 2014-05-27 13:34:46.0 | Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia | Epidemiology/Environmental History | Participant History and Family History | 4000 |
Free-Form Entry |
